The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal mechanism for alleviating hunger, improving nutrition, and increasing the food purchasing power of low-income households. Federal spending on SNAP has grown from $30 billion in FY 2007 to $78 billion in FY 2011, and in light of federal deficit reduction strategies, many policymakers are proposing changes to eligibility, benefit levels, and administrative elements of this means-tested entitlement program. During the 112^th Congress, significant cuts to SNAP were proposed in the full Senate and the House Agriculture Committee versions of the farm bill, S. 3240 and H.R. 6083, respectively. Similar proposals are expected during the 113^thCongress. We conducted a health impact assessment (HIA) to investigate the health implications of these proposed changes to SNAP. HIAs offer a practical way of identifying potential health effects of proposed policies, health implications which might not otherwise be fully recognized or addressed.

Research questions guiding the HIA focused on (1) how changes to SNAP could affect the health of those affected by the programmatic changes, highlighting impacts on food security, nutrition, and obesity and (2) under-recognized implications of the proposed changes, including impacts on economic mobility and work supports, and household budgetary trade-offs related to expenditures for basic needs such as energy, housing and access to health care. Stakeholder engagement was a critical aspect of the HIA to ensure that the analysis and recommendations were policy relevant and pragmatic. Stakeholder engagement included gathering input from members of an advisory committee, a bipartisan group of individuals from Congressional Committees, and other key informants. In addition, semi-structured interviews were conducted with SNAP participants and state and local SNAP administrators.

This analysis found that both proposed bills offer the potential for deficit reduction through lowering federal spending; however, the legislative proposals may place the health of low-income Americans at risk by eliminating or reducing benefits, and would therefore conflict with the high-priority federal objective stated in Healthy People 2020 of eliminating health disparities. The proposed changes to SNAP would likely increase the difficult economic tradeoffs of month-to-month budgeting for basic needs among low-income families and would also increase the chances of a family being food insecure, itself a health risk for a range of conditions, such as nutrition deficiencies, cognitive development, and mental health among adults and children. Specific evidence-based recommendations were developed, including for example, the need for federal agencies to promulgate guidance to states regarding options for dual administration of SNAP and Medicaid, and cross-program adoption of eligibility determination criteria, including assets and income under the Affordable Care Act beginning in 2014. These results provide an example of how HIA can be conducted on federal omnibus legislation to highlight health considerations during the policy debate.